Laparoscopy, or laparoscopic surgery, is a surgical procedure for gaining access to a patient's internal organs or tissue without making large incisions. Traditional surgical techniques required making a slit through a patient's skin, and frequently muscles and other tissue, to expose the organ or tissue to be operated.
Laparoscopy eliminates the need for large incisions, by providing access to the tissue or organ to be treated by making a number of relatively small holes through the patient's skin. These holes, typically having a diameter of between about 0.1 and 0.45 inch, may generally be located in, for example, a triangular arrangement in the vicinity of the tissue or organ to be operated on. Each of these holes serve multiple purposes. One of the holes may be used for inserting a tube through which gas is pumped, such as carbon dioxide to inflate the area around the organ or tissue to be operated on. In another of the holes, a camera or other device for transmitting a visual image of the surgical area, is inserted, such that the area undergoing surgery will be visible on a remote monitor.
In another of the holes, any one of a number of surgical instruments can be inserted. One of the instruments may be simply a probe or tube to allow fluid or debris to be passed therethrough, as will be described further below. Alternatively or additionally, the probe may have an integral or ancillary surgical instrument, such as a laser fiber, forceps, electrosurgical devices, or a cauterizing device. During the laparoscopic surgery, the surgeon manipulates the probe while watching the movement of the probe on the monitor.
Laparoscopic surgery gained its popularity in gynecological surgeries. The surgery is gaining popularity as it is being expanded to other specialists for diseases in other areas of the body, e.g. gall stones.
Because the laparoscopic patient does not have a large incision, the patient has a relatively short recovery time. A patient typically can return to nearly full activity within a matter of days. In contrast, the healing from a traditional type of incision can take considerably longer and be considerably more painful. Further, the danger of infection may be considerably reduced with laparoscopy.
The use of laparoscopic surgery is described in greater detail below through the example of the removal of a gall stone. It is to be understood, however, that the functions and operation of the laparoscopic equipment would be similar for a number of different types of surgical procedures.
To remove a gall stone, the laparoscopic procedure would begin with the making of four holes in a generally triangular pattern through the skin proximate the gall bladder. Into one of these holes, a tube would be inserted and carbon dioxide would be instilled therethrough to inflate the abdominal cavity. A camera or other detector for creating a visual image on a remote monitor would be inserted in the same or another of the holes, as described above. Probes and instruments would be inserted into the abdominal cavity. The surgeon would watch the surgical area on the monitor and manipulate the probe and instruments accordingly to appropriately treat the diseased organ. It is sometimes necessary to rinse or irrigate the area being operated on. This can be accomplished by providing fluid flow into the patient through a probe and thereafter vacuuming the fluid with the probe. The vacuum can also be used to remove blood, other fluids, smoke or debris from the surgical area.
To accomplish this irrigation and aspiration, it is desirable that one or more valves be provided to control flow of fluids and particles into and out of the surgical area.
It is further desirable that a valve for controlling irrigation and aspiration be generally unitary and that both aspiration and irrigation be operable with one valve, or with one switch or handle, for convenience of the user. It is further desirable that the valve be constructed so that clogging of debris within the valve is minimized.
Still further, it is desirable for a valve arrangement in conjunction with the probe to be operable to allow a range of flow volumes for both irrigation and aspiration. This is desirable because, for example, as gas and fluid are pulled through the probe to the atmosphere outside of patient's body, additional CO.sub.2 gas must be supplied to maintain relatively constant internal pressure. Typically the CO.sub.2 gas, under pressure, is cooler than the patient's body temperature, and therefore the body cools somewhat as CO.sub.2 gas is applied. It is preferable to maintain a relatively low flow rate of CO.sub.2 gas to minimize the cooling of the patient's body. Therefore, slow or controlled withdrawal of fluids and gases from the body may be desirable to minimize the replacement volume of the CO.sub.2 gas into the patient.
Existing probes typically have an outer shield tubing or sheath. In prior art probes, this shield is metallic or opaque. Because the probe sheath is not transparent, it is difficult for a surgeon or nurse to recognize from the image on the monitor when blood or fluid begins to be drawn into the probe until the blood is visible in the tubing outside the patient's body. Additionally, metallic tubes are undesirable because, when used with electrosurgical devices and cauterizing devices, capacitive coupling induces a current on the sheath tube, thereby causing it to burn tissue with which it comes into contact.
Thus, it would be desirable that a probe for use in laparoscopic surgery be made with a tube sheath of a clear material. With the use of clear material, the surgeon or nurse could immediately see that blood is passing into the probe tube. Further, a non-conductive material would not be subject to the build up of charge due to induced currents during electrosurgery and cauterizing, and therefore would not burn the tissue with which the probe comes into contact.